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VA hospital

Selene Pozzebon, Aaron Blandino Ortiz, Federico Franchi, Stefano Cristallini, Mirko Belliato, Olivier Lheureux, Alexandre Brasseur, Jean-Louis Vincent, Sabino Scolletta, Jacques Creteur, Fabio Silvio Taccone
BACKGROUND: Acute cerebral complications (ACC) of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are associated with poor long-term neurologic outcome. We described the role of rSO2 monitoring in detecting ACC and desaturations and their relationship with poor outcome when employing VA-ECMO. METHODS: Retrospective analysis of patients monitored by cerebral frontal near-infrared spectroscopy (NIRS) (CAS Medical Systems Inc., Branford, CT, USA) during VA-ECMO (November 2008-December 2015)...
March 20, 2018: Neurocritical Care
Iosif Gulkarov, James Schiffenhaus, Ivan Wong, Ashwad Afzal, Felix Khusid, Berhane Worku
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an invaluable rescue therapy for patients suffering from cardiopulmonary arrest, but it is not without its drawbacks. There are cases where patients recover their cardiac function, yet they fail to wean to mechanical conventional ventilation (MCV). The use of high-frequency percussive ventilation (HFPV) has been described in patients with acute respiratory failure (RF) who fail MCV. We describe our experience with five patients who underwent VA-ECMO for cardiopulmonary arrest who were successfully weaned from VA-ECMO with HFPV after failure to wean with MCV...
March 2018: Journal of Extra-corporeal Technology
Judy Tan, Anita Mehrotra, Girish N Nadkarni, John Cijiang He, Erik Langhoff, James Post, Carlos Galvao-Sobrinho, Henry C Thode, Rajeev Rohatgi
BACKGROUND: Chronic kidney disease (CKD) patients who live far (>30 miles) from their nephrologist experience lower rates of clinic visit adherence, limited access to treatment, and higher rates of hospitalization and mortality than patients who live in close proximity to their nephrologist. Strategies to minimize disparities between urban and remotely located CKD patients are needed. The purpose of this study was to determine whether adherence to clinic visits and clinical outcomes in the remote management of CKD via telenephrology is comparable to in-person conventional care...
March 20, 2018: American Journal of Nephrology
Tsunehiko Konomi, Kota Suda, Satoko Matsumoto, Miki Komatsu, Masahiko Takahata, Norimasa Iwasaki, Akio Minami
Introduction: There are considerable risks for vertebral artery (VA) injury in case of corrective surgery for a severe and rigid cervical kyphotic deformity. This case report describes a rare case of surgical management for pre-existing traumatic rigid cervical kyphosis associated with unilateral VA occlusion. Case presentation: A 73-year-old male fell down and injured his neck. He was referred to our hospital 10 months after injury because his degree of head drop progressed gradually to a chin-on-chest position such that he could not look straight forward...
2018: Spinal Cord Series and Cases
B Josea Kramer, Beth Creekmur, Michael N Mitchell, Debra Saliba
BACKGROUND/OBJECTIVES: Home-based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community-dwelling populations needing long-term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a "natural laboratory" to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support...
March 12, 2018: Journal of the American Geriatrics Society
Achim Fieß, Ruth Kölb-Keerl, Alexander K Schuster, Markus Knuf, Bernd Kirchhof, Philipp S Muether, Jacqueline Bauer
PURPOSE: The objective of this study was to investigate the relationship between visual acuity, peripapillary retinal nerve fibre layer (pRNFL), retinal thickness at the fovea and other factors with the neurologic status of former preterm children. METHODS: In this cross-sectional hospital based study in a maximum care tertiary centre, detailed anthropometric and ophthalmological data of former preterm children ranging from 4 to 10 years of age with a gestational age (GA) ≤32 weeks were assessed...
March 9, 2018: Acta Ophthalmologica
S Perez-Protto, R Nazemian, M Matta, P Patel, K J Wagner, S Q Latifi, D J Lebovitz, J D Reynolds
Many deceased by neurologic criteria donors are administered inhalational agents during organ recovery surgery-a process that is characterised by warm and cold ischaemia followed by warm reperfusion. In certain settings, volatile anaesthetics (VA) are known to precondition organs to protect them from subsequent ischaemia-reperfusion injury. As such, we hypothesised that exposure to VA during organ procurement would improve post-graft survival. Lifebanc (organ procurement organisation [OPO] for NE Ohio) provided the investigators with a list of death by neurologic criteria organ donors cared for at three large tertiary hospitals in Cleveland between 2006 and 2016-details about the surgical recovery phase were extracted from the organ donors' medical records...
March 2018: Anaesthesia and Intensive Care
Christopher J Udell, Julie L Ruddy, Philip M Procento
Introduction: US Navy recruits who have injuries preventing them from participating in intense physical conditioning are pulled out of boot camp training and receive treatment that includes daily physical therapy, pain medications, and psychoeducational groups. Graduation from boot camp for these recruits requires not only recovering from their injuries but also passing a required Physical Fitness Assessment consisting of a timed 1.5-mile run, curl-ups, and push-ups. About 50-60% of these recruits will eventually be separated out and sent home...
March 6, 2018: Military Medicine
Jasmohan S Bajaj, Leroy R Thacker, Andrew Fagan, Melanie B White, Edith A Gavis, Phillip B Hylemon, Robert Brown, Chathur Acharya, Douglas M Heuman, Michael Fuchs, Swati Dalmet, Masoumeh Sikaroodi, Patrick M Gillevet
BACKGROUND: Cirrhosis is associated with gut microbial changes, but current 16S rDNA techniques sequence both dead and live bacteria. We aimed to determine the rRNA content compared with DNA from the same stool sample to evaluate cirrhosis progression and predict hospitalizations. METHODS: Cirrhotics and controls provided stool for RNA and DNA analysis. Comparisons were made between cirrhotics/controls and within cirrhosis (compensated/decompensated, infected/uninfected, renal dysfunction/not, rifaximin use/not) with respect to DNA and RNA bacterial content using linear discriminant analysis...
March 8, 2018: JCI Insight
Elizabeth Holman, Cari Levy, Brenda Kennedy
Animal-assisted intervention is gaining attention as a stress reduction modality. Quantitative data demonstrate its effectiveness, as a recent study published in AJHPM supported that a Veterans Affairs (VA) hospital facility dog paired with a palliative care psychologist had a measurable impact on salivary cortisol levels and heart rate in hospitalized veterans. There remains an important role for qualitative insights. The Denver VA palliative care team learned a range of lessons from the sudden loss of their facility dog, many of which relate directly to palliative care...
January 1, 2018: American Journal of Hospice & Palliative Care
Yuewei Wu-Fienberg, Mary K Henzel, Mary Ann Richmond, Devra B Becker
CONTEXT/OBJECTIVE: Multiple medical specialties are often involved in the management of patients with both spinal cord injuries (SCI) and pressure injuries (PIs), sometimes leading to inadequate communication. Our Veterans Affairs (VA) hospital has an interdisciplinary team for PI patients in the SCI unit. This team conducts monthly bedside rounds and journal clubs; there is no similar team for patients with PIs outside the SCI unit. This pilot study aims to determine whether such an interdisciplinary team improves care coordination among practitioners...
March 6, 2018: Journal of Spinal Cord Medicine
Kai H Lee, Michael Qiu, Jiandong Sun
OBJECTIVES: The algorithm for maxillofacial trauma management is well defined; however, provision of alcohol assessment for patients after trauma is not widely practiced. This study aims to investigate the rate of alcohol assessment achieved within the demographic characteristics of patients with facial trauma and the circumstances where this intervention was implemented. STUDY DESIGN: This study retrospectively examined the Victorian Admitted Episodes Data Set (VAED) from 2004 to 2013...
February 1, 2018: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Guoping Peng, Jiajia Zhou
RATIONALE: Bilateral abducens nerve deficits caused by vertebral artery (VA) aneurysm have been reported, but there have been no reports regarding accompanying urinary retention. PATIENT CONCERNS: In this report, we describe an unusual case with bilateral abducens nerve palsy and urinary retention due to rupture of a vertebral aneurysm. DIAGNOSES: Subarachnoid hemorrhage caused by the rupture of a left VA aneurysm. INTERVENTIONS: The VA aneurysm was successfully controlled by coil embolization...
January 2018: Medicine (Baltimore)
Ashish Malhotra, Parkpoom Phatharacharukul, Charat Thongprayoon
BACKGROUND: Repeat hospitalizations in veterans with inflammatory bowel disease (IBD) are understudied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions. METHODS: A retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center (MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem...
February 8, 2018: Military Medical Research
Daniel P Challe, Mathias L Kamugisha, Bruno P Mmbando, Filbert Francis, Mercy G Chiduo, Celine I Mandara, Samuel Gesase, Omari Abdul, Martha M Lemnge, Deus S Ishengoma
BACKGROUND: Although death records are useful for planning and monitoring health interventions, such information is limited in most developing countries. Verbal autopsy (VA) interviews are alternatively used to determine causes of death in places without or with incomplete hospital records. This study was conducted to determine all causes and cause-specific mortality in Korogwe health and demographic surveillance system (HDSS) undertaken in Korogwe district, northeastern Tanzania. METHODS: The study was conducted from January 2006 to December 2012 in 14 villages under Korogwe HDSS...
February 27, 2018: Malaria Journal
Norihiko Ishizaki, Teruyo Kida, Masanori Fukumoto, Takaki Sato, Hidehiro Oku, Tsunehiko Ikeda
BACKGROUND: To describe a retrospective study of macular retinoschisis that developed long after the onset of retinal artery occlusion (RAO) using optical coherence tomography (OCT). METHODS: We describe changes in macular findings and visual acuity (VA) of 29 patients (21 males and 8 females, mean age: 66.1 ± 16.9 years) with RAO (18 branch RAOs [BRAOs] and 11 central RAOs [CRAOs] who visited Osaka Medical College Hospital over an 8-year period based on a medical chart review...
February 27, 2018: BMC Ophthalmology
Charlene A Pope, Boyd H Davis, Leticia Wine, Lynne S Nemeth, Robert N Axon
Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
Thomas H Hansen
At a VA hospital, wait times for gastroenterology care have been in the order of 60 to 90 days for new clinic consults. Through a quality improvement process, these times were reduced to less than 30 days. With a revised triage process, the number of consults needing to be scheduled into the clinic was reduced 34%. In addition to achieving rapid clinical access, the weekly half-day clinic became less congested and more efficient. We describe this process of achieving improved access.
March 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
Edward Alan Miller, Orna Intrator, Emily Gadbois, Stefanie Gidmark, James L Rudolph
This study identifies factors VA staff perceived to promote or impede home and community-based services (HCBS) placement post-hospital discharge among Veterans cared for within the U.S. Department of Veterans Affairs (VA). Data derive from 35 semi-structured interviews with staff from 12 VA Medical Centers from around the country. VA staff reported that Veterans' care needs and social and financial resources influence HCBS placement. They also reported prerequisites for successful placement, including housing, unpaid informal care, and non-VA services funded privately and by public programs such as Medicaid and the Older Americans Act...
February 22, 2018: Journal of Aging & Social Policy
Stefan Andric, Dragica Tesic, Dalibor Somer, Ilija Srdanovic, Tatjana Miljkovic, Djordje G Jakovljevic, Lazar Velicki
OBJECTIVE AND IMPORTANCE: Endless loop tachycardia or pacemaker-mediated tachycardia, and atrioventricular desynchronization arrhythmia or repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) are two forms of reverse impulse conduction - ventriculoatrial (VA) synchrony. Although VA synchrony can theoretically cause aggravation of heart failure, clinical cases describing severe consequential heart failure are lacking. CLINICAL PRESENTATION AND INTERVENTION: We describe a case of a 60-year-old patient who underwent primary percutaneous coronary intervention and mitral valve surgery...
February 21, 2018: Acta Clinica Belgica
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